Hispanics often treated by lower quality surgeons

Hispanics often treated by lower quality surgeons
By Joene Hendry, REUTERS, Jul 10, 2009

NEW YORK (Reuters Health) - Hispanic men and women needing heart-bypass surgery are about 50 percent more likely than white patients to undergo an operation by lower quality surgeons, according to research conducted in Massachusetts.

By contrast, African-American patients were no more or less likely than white patients to undergo such operations by lower quality cardiac surgeons, defined by the risk of patients' dying within 30 days of surgery, report Dr. Luis R. Castellanos, at the University of California, Davis Medical Center in Sacramento, and colleagues.

Their study assessed racial and ethnic disparities in access to higher quality heart surgeons in Massachusetts, a state that "prides itself in providing comprehensive and equitable care to its residents," Castellanos told Reuters Health.

Coronary artery bypass grafting reroutes blood from blocked to unblocked arteries that will better deliver blood to the heart muscle. The investigators compared 56 cardiac surgeons who performed 12,973 of these surgeries in Massachusetts residents during 2002 through 2004.

The patients, 74 percent male, were 67 years old on average. Overall, 91 percent were white, while 3.2 and nearly 2 percent were Hispanic and African-American, respectively, the researchers report in the American Journal of Cardiology.

Among Hispanic patients, 1.8 percent had a lower-risk cardiac surgeon while 4.9 percent had a higher-risk surgeon.

Compared with white patients, Hispanic patients were almost 3 times more likely to be operated on by higher risk rather than lower risk surgeons.

"Even after adjusting for traditional clinical risk factors, demographic characteristics, and urgency of procedure, Hispanic patients (compared with white patients) in Massachusetts were more likely to be operated upon by cardiac surgeons with lower quality performance rates," noted Castellanos.

By contrast, the investigators found white and African-American patients about equally as likely to have higher and lower risk surgeons.

Still, the cardiac surgeons involved in this analysis had very similar risk-adjusted mortality rates that were "lower than the national average," Castellanos said.

SOURCE: American Journal of Cardiology, June 15, 2009.